Empowering Ourselves and Others

Marisa Kawata Watanabe, DDS, MS

History, law, music, economics, business administration, and then there was me — molecular and cell biology. I grew up surrounded not by dentistry, discussions about navigating that crafty MB2 or spending time in the dental office, but instead found myself helping with paralegal activities in a law office, playing sports and volunteering in the community. Like some (or maybe a few) of you, beyond dental visits, my exposure to the dental field was limited up until college. It was at University of California, Berkeley, where my civic and social responsibilities collided, where I learned about health disparities and inequities among populations and communities and discovered that dentistry expands beyond private practice delivery systems.

The notion of social responsibility has long been considered economic and professional obligations in dentistry. Without searching the phrase in a web browser, or dare I say, opening an actual dictionary, we can infer by separating each word that there is an innate responsibility we take on toward all society once we receive our diploma and are called “doctor.” The recently published 2021 U.S. surgeon general report entitled “Oral Health in America: Advances and Challenges” noted that despite over 20 years since the last U.S. surgeon general’s report in 2000, data currently reflect that the number of health disparities, especially among low socioeconomic populations, has continued through the present day. 1 Furthermore, the 2021 U.S. surgeon general report documented that Americans living in chronic poverty, including populations from specific racial and ethnic minority groups, continue to show the greatest burden of disease. 1

I found myself wondering, what are ways to further support system-level changes, inspire the future workforce, work collaboratively with our private and community providers as well as educational institutions and advocate for health equity? National, state and local frameworks have provided clear goals and objectives, so why has the level of health disparities remained similar to 20 years ago, 1 and how do we push the needle beyond equality toward equity and, eventually, justice for all people? The 2021 U.S. surgeon general report made a call to action loud and clear, focusing on policy changes addressing social, economic and other systemic inequities, interprofessional collaborative practice among all health care professionals and increasing diversity of the future dental workforce while reassessing dental student loan debt for the next generation of oral health providers. 1

With approximately 65 million people in the U.S. currently residing across 6,837 dental Health Professional Shortage Areas (dental HPSAs), an additional 11,320 oral health providers are needed to fulfill the lack of oral health care in these dental HPSAs. 2 In California alone, 501 dental HPSAs exist, the largest number of all 50 states. 2 By marrying both federal and state incentivization programs, future and current dentists can apply for scholarships and grants that not only help to navigate and incentivize providers to work in dental HPSAs or practices accepting Medicaid dental, but also support reducing student indebtedness. But as a practitioner or a graduating dental student interested in pursuing one of these scholarships and grants, where can one turn to for a centralized scholarship/grant bank? Currently, social media, publications and word of mouth are the main sources of information dissemination and navigating the search process can be daunting. Fortunately, both the California Dental Association 3 and the American Dental Education Association 4 list opportunities such as the state California Department of Health Care Services CalHealthCares loan repayment program and the federal National Health Scholarship Corps loan repayment program for interested practitioners. These opportunities can be found via a simple search engine keyword query. With almost all dental students graduating with educational debt and current dentists still holding student loans, programs and scholarships to explore and address student loans will also draw oral health providers to medically underserved communities.

Beyond encouraging future and current dental providers to practice in medically underserved communities, local dentists and private practices have also supported addressing barriers caused by economic and social determinants in their own communities. Returning to the original question — how can private practice and community health centers work collaboratively? — the Centers for Medicare and Medicaid Services developed one method through a federal regulation in 2011 that allows federally qualified health centers (FQHCs) to contract with private dental offices for referred delivery of oral health care services. 1 Also at the federal level, the Health Resources and Services Administration continues to award infrastructure grant dollars to FQHCs to expand or enhance their current oral health services, including collaborative partnerships with private practices. 1 By working in partnership and pooling resources, FQHCs have been able to increase their oral health capacity through the infrastructure expansion and together increase accessibility to dental services in and around surrounding communities. 1 In addition to establishing formalized partnerships, private and community practitioners have also joined together for community events, including offering space to host one-day or weekend health day events and volunteering at events such as CDA Cares.

The Healthy People 2030 objectives highlighting oral health needs as one of the disparate health conditions require the participation and support of entities outside of the oral health profession. Legislators, community and dental organizations, public health departments, promotoras, educational institutions and, most importantly, the community along with health care professionals must create a symbiotic relationship to achieve oral health equity. By bridging the gap between primary care and oral health providers, we can further address other areas of systemic health such as obesity, diabetes and other health conditions listed in Healthy People 2030. 5 For example, FQHCs and private practices, in addition to oral health services, provide a bidirectional partnership with the FQHC providing a medical home for patients of the private practice who lack medical care due to being under- or uninsured. Interprofessional collaborative practice beyond interdisciplinary integration in the dental field to build relationships between community and private practitioners will further support the 2021 U.S. surgeon general report’s call to action.

Though my exposure to dentistry may have been limited during my growing years, my family introduced philanthropic work and service early on. As a member of a local Optimist Club, from age 5 through high school, whose mission focuses on promoting “an active interest in community affairs, to work for fellowship among all people and to aid and encourage the development of youth,” I believe that as oral health providers, we can incorporate both civic and social responsibilities into our profession. By doing so, not only will we encourage a dental workforce to explore and consider providing service in medically underserved communities, but we will also play a pivotal role in improving the health of our local communities, state and nation. There were gains since the 2000 U.S. surgeon general report, such as implementation of creative programs, data collections and developments. But most importantly, the impact seen 20 years later is that far more sustainable work needs to be done to address the health disparities and inequities that exist. 1 I encourage all dental professionals to take an opportunity to volunteer, mentor a predental or dental student or a new grad and explore different delivery systems that increase access to care and foster oral and overall health equity for all. n

Marisa Kawata Watanabe, DDS, MS, is a professor and associate dean for community partnerships and access to care at the Western University of Health Sciences, College of Dental Medicine. She currently serves on the board of the Medicaid|Medicare|CHIP Services Dental Association as the academic director and is the chair of the Los Angeles County Department, Oral Health Program Community Oral Health Improvement Plan, Workforce Development and Capacity Workgroup.